Age-Related Outcomes After Transcatheter Aortic Valve Replacement: Insights From the SwissTAVI Registry.

ABSTRACT

OBJECTIVES: The aim of this study was to investigate age-related outcomes of patients undergoing transcatheter aortic valve replacement (TAVR) as assessed in a nationwide, prospective, multicenter cohort study. BACKGROUND: TAVR is the preferred treatment for elderly patients with severe aortic stenosis and is expanding into lower age groups. METHODS: Data from the SwissTAVI Registry were analyzed. Clinical outcomes were compared between patients 70 years of age or younger (n = 324), 70 to 79 years of age (n = 1,913), 80 to 89 years of age (n = 4,353), and older than 90 years of age (n = 507). Observed deaths were correlated with expected deaths in the general Swiss population using standardized mortality ratios. RESULTS: Between February 2011 and June 2018, 7,097 patients (mean age 82.0 ± 6.4 years, 49.6% women) underwent TAVR at 15 hospitals in Switzerland. Procedural characteristics were similar; however, older patients more often had discharge to the referring hospital or a rehabilitation facility after TAVR. Using adjusted analyses, a linear trend for mortality (30-day adjusted hazard ratio [HRadj] 1.45; 95% confidence interval [CI] 1.18 to 1.77; 1-year HRadj 1.12; 95% CI 1.01 to 1.24), cerebrovascular accidents (30-day HRadj 1.35; 95% CI 1.09 to 1.66; 1-year HRadj 1.21; 95% CI 1.02 to 1.45), and pacemaker implantation (30-day HRadj 1.23; 95% CI 1.12 to 1.34; 1-year HRadj 1.19; 95% CI 1.09 to 1.30) was observed with increasing age. Furthermore, standardized mortality ratios were 12.63 (95% CI 9.06 to 17.58), 4.09 (95% CI 3.56 to 4.74), 1.63 (95% CI 1.50 to 1.78), and 0.93 (95% CI 0.76 to 1.14) for TAVR patients in relation to the Swiss population <70, 70 to 79, 80 to 89 and ≥90 years of age, respectively. CONCLUSIONS: Increasing age is associated with a linear trend for mortality, stroke, and pacemaker implantation during early and longer-term follow-up after TAVR. Standardized mortality ratios were higher for TAVR patients younger than 90 years of age compared with expected rates of mortality in an age- and sex-matched Swiss population. (SWISS TAVI Registry; NCT01368250).